All the neonates (242) suffered from moderate to severe respiratory distress, identified by clinical signs, chest X-ray, respiratory distress syndrome (RDS) score >6, and blood gas measurements. All the neonates included were treated by administering surfactant (Beractant or Poractant alfa, dosage 100 mg/kg).

The INSURE method was “successful” in 74% of patients, meaning there was no need for a second dose of surfactant or mechanical ventilation repetition. The factors that determined the “success” (Table II) were as follows: type of delivery, weight, GA, and number of fetuses. The factors affecting survival were: number of fetuses, mechanical ventilation dependency, pregnancy complications, and type of surfactant. The INSURE method reduced mortality (91.3% survived). Keywords : respiratory distress, respiratory distress syndrome (RDS), surfactant, INSURE method, mechanical ventilation.